Healthcare Provider Details

I. General information

NPI: 1558440198
Provider Name (Legal Business Name): CHILDREN'S THERAPY OF WOODINVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19021 120TH AVE NE STE 102
BOTHELL WA
98011-9511
US

IV. Provider business mailing address

19021 120TH AVE NE STE 102
BOTHELL WA
98011-9511
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-7710
  • Fax: 425-483-6059
Mailing address:
  • Phone: 425-486-7710
  • Fax: 425-483-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT00001028
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT00007212
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT00005002
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT00002112
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00003722
License Number StateWA
# 8
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00002375
License Number StateWA
# 10
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00003980
License Number StateWA
# 11
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL00003905
License Number StateWA
# 12
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN CLUTTER
Title or Position: OWNER/CLINIC MANAGER
Credential:
Phone: 425-486-7710